Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,018.52 / $2,747.00 / $7,920.26	Facility		$1,018.52	$2,747.00	$7,920.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $795.69 / $1,121.70 / $1,276.91	Professional		$795.69	$1,121.70	$1,276.91
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $505.10 / $1,001.43 / $1,471.70	Facility		$505.10	$1,001.43	$1,471.70
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $683.84 / $969.29 / $1,030.46	Facility		$683.84	$969.29	$1,030.46
Providence Facility/Professional Facility Modifier Low / Median / High Price $505.10 / $1,108.17 / $1,451.81	Facility		$505.10	$1,108.17	$1,451.81
Providence Facility/Professional Facility Modifier 80 Low / Median / High Price $197.47 / $197.47 / $197.47	Facility	80	$197.47	$197.47	$197.47
Providence Facility/Professional Facility Modifier AS Low / Median / High Price $167.85 / $167.85 / $167.85	Facility	AS	$167.85	$167.85	$167.85
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,722.14 / $2,722.14 / $2,722.14	Facility		$2,722.14	$2,722.14	$2,722.14
United Facility/Professional Facility Modifier Low / Median / High Price $2,364.00 / $7,664.00 / $36,803.00	Facility		$2,364.00	$7,664.00	$36,803.00